Collaboration Over Competition: Making Children’s Hospitals Safer

Patient Safety Half of the nation’s children’s hospitals are binding together to help reduce medical errors and unnecessary loss.

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A SAFER HORIZON: Commitment to zero patient harm and preventable death is the first step towards achieving it.

While most industries consider staying competitive a key to success, a group of hospitals in the United States uniting for the common good of their patients is seeing more success with collaboration.

Seeking perfection

Children’s Hospitals Solutions for Patient Safety (SPS), a national effort that began in 2009, in Ohio, has brought over 80 children’s hospitals together to identify best practices and to reduce common medical errors that harm young patients.

“There was a principle that we adopted early on—and it’s that when it comes to safety, we won’t compete with each other, and in fact we’re going to collaborate to learn from each other to advance safety for all of us,” says SPS co-founder Michael Fisher, also the chairman of the SPS board and CEO of Cincinnati Children’s Hospital Medical Center

The initiative, which is being spearheaded at over half of the nation’s children’s hospitals, including Cincinnati Children’s, has met various milestones since its inception, including: reducing the rates of serious falls by 81 percent, hospital-acquired infections such as urinary tract infections (25 percent reduction), surgical site infections (31 percent) and central line-associated blood stream infections by 11 percent, ventilator-associated pneumonias by 47 percent, medication errors by 42 percent and pressure ulcers by 27 percent as well as other types of serious harm events.

To date, SPS has addressed 10 types of harm that occur in children’s hospitals.

Complications

“The initial phase of the improvement work is especially disheartening because often the rates of harm go up, as the systems designed to detect and catalogue events of harm in the hospital mature and identify the harm that is happening,” says SPS co-clinical director Anne Lyren, strategic advisor of quality and safety at UH Rainbow Babies & Children's Hospital.

“If nothing else, we’re honoring those families where their child has been harmed by not just saying we’ll improve locally, but we will use this learning to improve nationally.”

“However,” Lyren says, “nearly every hospital that participates in our network has reaped the rewards of the work over time as they watch their rates drop, and know that so many children and their families were spared harm.”

SPS’s achievements are the product of data sharing and changing the culture dynamic in hospitals themselves, says Fisher and Dr. Stephen Muething, VP Safety of Cincinnati Children's Hospital, who also helped execute the effort.

“It’s not easy to challenge and speak up to someone with authority,” Fisher notes. “One of the cultural things that I think is a work in progress but that we’ve seen significant progress in with nurses and patient care service employees is to say to others in their organizations that when something doesn’t look or feel right, or when something isn’t consistent with the established bundle of practices, you need to pause and do it differently.”

Who’s joining?

The majority of the individuals leading SPS’s efforts have experienced the consequences of hospital errors at a children’s hospital, either personally or with their children. Fisher noted that three-quarters of the participating hospitals have adopted SPS’s standard to have family members of affected patients sit on their boards, thus engaging in monthly conversations about the hospitals’ quality of safety reviews.

“One thing we hear from families who’ve gone through this is they will say unanimously: ‘What can we now do so that no other family has to be sitting where we’re sitting?’” Muething says. “If nothing else, we’re honoring those families where their child has been harmed by not just saying we’ll improve locally, but we will use this learning to improve nationally.”